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Publication Economic Impact of Implementing Malnutrition Screening and Nutritional Management in Older Adults in General Practice(Elsevier, 2020-03) Brown, Fiona; Fry, Gemma; Cawood, Abbie; Stratton, Rebecca; Brown, Fiona; Fry, Gemma; Allied Health ProfessionalObjectives: Malnutrition is a common and significant public health problem, especially for older adults, as the consequences are costly. National guidelines (NICE CG32/QS24) highlight the need to identify and manage malnutrition, the implementation of which was deemed "high impact to produce cost savings". The 'Malnutrition Pathway', endorsed by NICE and other professional bodies, is a practical evidence-based guide to help community healthcare professionals (HCP) to implement guidance on malnutrition management. Published evaluations of its use are needed. Design: This service evaluation in older adults assessed the impact of implementing the 'Malnutrition Pathway' on health care use and costs, as well as the acceptability of the management strategies and effect on malnutrition risk. Setting: 5 GP surgeries in Gloucestershire. Participants: 163 older adults (80±9 years) with a range of primary diagnoses, living in their own home, were screened using the Malnutrition Universal Screening Tool ('MUST') (n50 low risk (LR); n41 medium risk (MR); n72 high risk (HR)). All patients were managed according to risk (LR: no further management; MR: dietary advice (DA); and HR: DA plus two oral nutritional supplements (ONS) (1 serve 300kcal, 18g protein; 125ml). Measurements: At each review (6weeks, 3 and 6 months), 'MUST' score, compliance and satisfaction to their management plan were recorded. Healthcare use was collected from GP records 6 months before and after implementation of the pathway. A simple cost analysis was completed. Results: Implementing appropriate management of malnutrition led to significant reductions in hospital admissions (p=0.028), length of hospital stay (p=0.05), GP visits (p=0.007) and antibiotic prescriptions (p=0.05). Over 6 months, the costs to manage malnutrition (HCP time, ONS) were more than offset by the savings associated with these reductions in health care use (per patient savings of -£395.64 MR+HR; -£997.02 HR). The proportion of individuals at risk of malnutrition reduced over time, and patients reported being satisfied with the DA (97%) and ONS (96%), consuming 90% of their ONS prescription. Conclusion: Managing malnutrition significantly reduces healthcare use, with a positive budget impact, in older malnourished patients in primary care. This represents an opportunity to improve patient care with benefit on health care spend.Publication Complex Enterally Tube-Fed Community Patients Display Stable Tolerance, Improved Compliance and Better Achieve Energy and Protein Targets with a High-Energy, High-Protein Peptide-Based Enteral Tube Feed: Results from a Multi-Centre Pilot Study(MDPI, 2020-11-18) Green, Benjamin; Sorensen, Katy; Phillips, Mary; Green, Lisa; Watson, Rachel; McCallum, Adrienne; Brook, Sarah; Oldham, Sibohan; Barry, Michelle; Tomlinson, Lyndsey; Williams, Alice; Crease, Sam; Wills, Carrie; Talbot, Rose; Thomas, Rourke; Barker, Julie; Owen, Annalisa; Davies, Judith; Robinson, Carys; Lumsdon, Anna; Morris, Samm; McMurray, Chloe; Cunningham, Nicole; Miller, Lily; Day, Carolyn; Stanley, Kristina; Price, Susan; Duff, Susan; Julian, Anna; Thomas, Jennifer; Fleming, Carole-Anne; Hubbard, Gary; Stratton, Rebecca; Oldham, Siobhan; Barry, Michelle; Tomlinson, Lyndsey; Williams, Alice; Allied Health ProfessionalThis pilot study evaluated a high-energy, high-protein, peptide-based, (medium-chain triglycerides) MCT-containing enteral tube feed (Nutrison Peptisorb Plus HEHP®, Nutricia Ltd., Trowbridge, BA14 0XQ, UK.) containing 1.5 kcal/mL and 7.5 g protein/100 mL. Fifteen community-based, enterally tube-fed adults (42 (SD 16.3) years) received the intervention feed daily for 28 days, with gastrointestinal tolerance, compliance and nutrient intake assessed at baseline and after the intervention period. Incidence and intensity of constipation (p = 0.496), nausea (p = 1.000), abdominal pain (p = 0.366) and bloating (p = 0.250) remained statistically unchanged, yet the incidence and intensity of diarrhoea improved significantly after receiving the intervention feed (Z = -2.271, p = 0.023). Compliance with the intervention feed was significantly greater compared to the patient's baseline regimens (99% vs. 87%, p = 0.038). Compared to baseline, use of the intervention feed enabled patients to significantly increase total energy (1676 kcal/day (SD 449) to 1884 kcal/day (SD 537), p = 0.039) and protein intake (73 g/day (SD 17) to 89 g/day (SD 23), p = 0.001), allowing patients to better achieve energy (from 88% to 99%, p = 0.038) and protein (from 101% to 121%, p < 0.001) requirements. This pilot study demonstrates that a high-energy, high-protein, peptide-based, MCT-containing enteral tube feed maintains gastrointestinal tolerance and improves compliance, energy and protein intake in complex, enterally tube-fed, community-based adult patients, though more work is recommended to confirm this.Publication Reduce, reuse, recycle: Improving patient experience and environmental impact(Elsevier, 2022-03-22) Williams, Sarah; Oldham, Siobhan; Morgan, Annabel; McCarten, Fiona; Williams, Sarah; Oldham, Siobhan; Morgan, Annabel; Additional Clinical Services; Allied Health ProfessionalThe Trust declared a climate emergency in 20191, recognising the impact of climate change and the need for urgent action towards the aim of achieving carbon neutrality before 2050. The Trust has targeted several areas, with the reduction of waste as a key goal1.Publication Critically ill patients with and without SARS-CoV-2 better achieve energy and protein targets with a high-energy, high-protein peptide-based enteral tube feed; insights from a multicentre clinical audit performed during the COVID-19 pandemic(Elsevier, 2022-03-22) Green, Ben; Phillips, Mary; Morgan, Lucy; Hughes, K; Terblanche, Ella; King, S; Fiddes, Alex; Atwal, Kiranjit; Hubbard, Gary; Stratton, Rebecca; King, SMeeting energy and protein requirements in critically ill patients is important for prognosis, yet difficult to achieve as a consequence of disease, management and/or altered nutritional intake[1]. Improvements in achieving energy and protein requirements with a high-energy, high-protein peptide-based tube feed were observed in community patients with impaired gastrointestinal function[2]. To establish whether this remained true in the critical care setting, where feeding intolerance is observed frequently in patients with[3] and without SARS-CoV-2[4], a retrospective multicentre audit was performed. Adults (> 18years) with or without SARS-CoV-2, admitted to critical care across 6 UK hospitals between May 2020 and December 2020, were retrospectively included if they received a peptide-based enteral tube feed (Nutrison Peptisorb Plus HEHP®, Nutricia Ltd), containing 1.5kcal/ml and 7.5g protein/100ml (herein referred to as HEHP). Data were collected from 15 critically ill patients (52±12y; 87% male), with mean length of hospital stay being 26days (range: 7-49days). Of these, 10 were SARS-CoV-2 positive, with the remainder having pancreatitis (n=3), delayed gastric emptying (n=1) or unconfirmed diagnosis (n=1). HEHP was used second line (after whole protein) and indications (multiple were cited for some) for use included tolerance issues (n=10), elevated energy and protein requirements (n=5) or due to primary diagnosis (n=2). Estimated energy and protein intakes (% of requirements achieved) were recorded before and during use of HEHP. In addition, Dietitians were asked whether HEHP allowed patients to better meet their nutrient target Mean intake of HEHP was 2008±461kcal/day and 100±23g protein/day provided over a mean of 12days (range: 3-29days). The percentage of estimated energy and protein targets achieved increased albeit non significantly with the use of HEHP (from 76% before vs 87% during use of HEHP for both) and the direction of effect remained true regardless of SARS-CoV-2 status. Two thirds (67%, n=10 of 15) of Dietitians reported HEHP helped patients better meet their nutrient targets and 87% (n=13 of 15) of Dietitians perceived the high protein content of HEHP as beneficial for this patient group. Gastrointestinal tolerance (anecdotal reports) remained largely unchanged in approximately half of SARS-CoV-2 positive patients when using HEHP yet improved for others including non-SARS-CoV-2 patients. Enteral tube feeding in critically ill patients poses numerous difficulties, especially in SARS-CoV-2 positive patients. This audit in critically ill patients demonstrates that a high-energy, high-protein, peptide-based enteral tube feed can help complex patients better achieve energy and protein targets in patients with and without SARS-CoV-2.Publication Compliance and tolerance of a ready-to-use, low calorie, low volume, high protein modular feed in patients with increased protein needs(Elsevier) Green, Benjamin; Hampshire-Jones, Kate; Brooks, Catriona; McKinnon, Samantha; Oldham, Siobhan; Baldwin, Laura-Marie; Tomlinson, Lyndsey; Williams, Ali; Warsop, Ella; Caygill, Emma; Oldham, Siobhan; Baldwin, Laura-Marie; Tomlinson, Lyndsey; Williams, Ali; Warsop, Ella; Caygill, Emma; Allied Health ProfessionalMany clinical conditions warrant high protein intakes with recommended requirements ranging between 1.0-1.5g/kg BW-1. Despite these recommendations, it can be challenging for Dietitians to provide adequate levels of protein with standard enteral tube feeds and oral nutritional supplements alone, especially where caloric overfeeding and/or fluid restriction are a concern[1]. In these populations, additional protein provided via modular feeds may prove beneficial[2]. Currently available protein modular feeds are mostly composed of hydrolysed collagen and require preparation prior to feeding. The need for preparation prior to feeding increases the risk of contamination, incorrect preparation and inadequate provision of volume that could ultimately impact nutritional status, clinical and functional outcomes.Publication The impact of jejunostomy feeding on nutritional outcomes after oesophagectomy(Wiley, 2023-10-03) Davies, Sarah; Wheelwright, Sally; Davies, Sarah; Allied Health ProfessionalBackground: Nutritional status is compromised long-term following oesophagectomy. Controversy surrounds the optimal route for nutrition support postoperatively and there is wide variation in the use of feeding jejunostomy tubes. Methods: A retrospective service evaluation was conducted for all consecutive adults who underwent oesophagectomy for a cancer diagnosis within a specialist centre between April 2016 and July 2019 (n = 165). Nutritional and clinical outcomes were compared for patients who received jejunostomy feeding (n = 24), versus those who did not (n = 141). Results: Patients with feeding jejunostomy lost significantly less weight at both 6 and 12 months postoperatively compared to those without jejunostomy (p ≤ 0.001 and p = 0.001, respectively). This remained statistically significant in multiple regression, controlling for age, gender, preoperative tumour staging and adjuvant treatment (p ≤ 0.001 and p = 0.03, respectively). Median length of home enteral feeding was 10 weeks after discharge in the jejunostomy group. We observed minor jejunostomy tube-related complications in four patients (16.7%). Of those readmitted within 90 days of surgery in the non-jejunostomy group, nutritional failure was a factor in 43.2% of these readmissions. "Rescue tube feeding" was required by 8.5% of the non-jejunostomy group within the first postoperative year, including 6.4% within 90 days of surgery. Conclusions: Use of short-term supplementary jejunal feeding in addition to oral intake after hospital discharge is beneficial for maintaining weight after oesophagectomy. We suggest a future randomised-controlled trial to confirm these findings.Publication Addressing multicultural dietary demand in dietetics: A handbook for dietitians(Association of British Clinical Diabetologists, 2024-07-25) Ramlan, Gabby; Kariyawasam, Deepa; Chandrasekharan, Lakshmi; Dawe, Sue; Gregory-Smith, Severine; Patel, Ruple; Dawe, Sue; Allied Health ProfessionalNo abstract available